Arizona Homeschool Affidavit – Fill Out and Use This PDF

AFFIDAVIT OF INTENT TO HOMESCHOOL

Dr. Donald D. Covey – Maricopa County Superintendent of Schools

Maricopa County Education Service Agency

STUDENT INFORMATION:

NAME: _______________________________________________________ DATE OF BIRTH: ___________________________

(LAST, FIRST, MIDDLE)

SCHOOL DISTRICT OF RESIDENCE: ______________________________

PARENT/GUARDIAN INFORMATION:

NAME: ________________________________________________ TELEPHONE NUMBER: ______________________________

(LAST, FIRST, MIDDLE)

HOME ADDRESS: _____________________________________ CITY: _________________________ ZIP: _________________

ARIZONA STATE HOMESCHOOL LAWS FOR REGISTRATION AS PRESCRIBED BY THE ARIZONA REVISED STATUTES:

15-802 A: Every child between the ages of six and sixteen years shall attend a school and shall be provided instruction in at least the subjects of reading, grammar, mathematics, social studies and science. The person who has custody of the child shall choose a public, private or charter school or a homeschool as defined in this section to provide instruction.

15-828 B: If a child is instructed at home pursuant to section 15-802, the person who has custody of the child shall, within thirty days after the home instruction begins, provide to the county school superintendent of the county in which the child resides one of the following:

1.A certified copy of the child's birth certificate.

2.Other reliable proof of the child's identity and age, including the child's baptismal certificate, an application for a social security number or original school registration records and an affidavit explaining the inability to provide a copy of the birth certificate.

3.A letter from the authorized representative of an agency having custody of the pupil pursuant to title 8, chapter 2 certifying that the pupil has been placed in the custody of the agency as prescribed by law.

I ELECT TO NOT BEGIN FORMAL EDUCATION UNTIL MY CHILD IS EIGHT YEARS OF AGE.

AUTHORIZATION:

PARENT/GUARDIAN SIGNATURE: _____________________________________________________

NOTARY SIGNATURE: ________________________________________________________________

Submit this form either by mail or in person to the Homeschool Services Division at the address listed on the bottom of this page. An original birth certificate must be presented for registration.

4041 N. Central Avenue, Ste. 1100, Phoenix AZ 85012 • Phone 602-506-3866 • Fax 602-506-3753

Homeschool Hotline 602-506-3144